dermatology presentation 25 oct 2012 final

7/31/2019 Dermatology Presentation 25 Oct 2012 Final

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http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/
http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/http://www.flickr.com/photos/epsos/4883281674/sizes/o/in/photostream/


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Click to edit Master subtitle style

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Dermatology: skin healthand disease

Catherine HydeGP and Teaching fellowYear 1 clinical co-lead25th November 2012


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What % of thepopulation is affected by

skin problems at anytime?

A. 2%B. 10%

C. 30%

D. 70%


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What % of thepopulation is affected by

skin problems at anytime?

A. 2%B. 10%

C. 30%

D. 70%


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Plan

What do I need to know

Keratinocytes & psoriasis

80 year old man with a skinlesion

keratinocytes andmelanocytes

Questions


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What do I need to know?

Knowledge

Normal skin and how this relates topathology

Terminology for skin Common disease

Systemic disease with skin manifestations

Rare and serious disease: recognition andreferral

Common benign conditions


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What do I need to know?

SkillsTaking history and examining skin

Pattern recognition

Managing uncertainty

epSos.de.Cute

Dog

Puppy

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http://www.flickr.com/photos/epsos/4883281674/http://www.flickr.com/photos/epsos/4883281674/http://www.flickr.com/photos/epsos/


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What is the main

function of the skin?A. Protecting from mechanical

stresses and micro-organisms

B. Synthesis of vitamin D

C. Regulating body temperatureand fluid loss

D. Sensing the environment andpotential damage


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What is the main

function of the skin?A. Protecting from mechanical

stresses and micro-organisms

B. Synthesis of vitamin D

C. Regulating body temperatureand fluid loss

D. Sensing the environment andpotential damage


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Normal Skin


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Epidermis
http://www.flickr.com/photos/gusilu/


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Keratinocytes

Epidermis is mostly keratinocytes,migrate from the basal layerdifferentiating

40-50 days

Active in Vitamin D synthesis


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Psoriasis

Mysiana (2007) Pink. Flickr.com [accessed18/03/2012] http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/

KeratinocyteAbnormal differentiationHyperproliferation

PsoriasisCommon 1-2% populationMultiple lesionsSeparate (discrete)On knees and arms (extensor

surfaces)

DiscoidRed/erythematous/salmonpink

Scaly
http://www.flickr.com/photos/mysiann/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/1638705074/sizes/l/in/photostream/http://www.flickr.com/photos/mysiann/


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Psoriasis

Treatment LadderTopicalMoisturisersCoal tar

vitamin D analoguesImmunosuppressants(Steroids/dithranol )

For widespread diseasePhototherapyChemotherapy (lowdose)Biological therapy


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Skin Treatment ingeneral

Nothing - reassure and advised

Review eg after 6weeks

Put something on it - moisturiser

- antifungal/antibiotic

- steroid

-immunosuppressant/specials

Take something for it :antibiotic/antifungal/immunosupressant

Burn it off cauter cr othera


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80 yr old man

SenileKeratosisSenile : older ageKeratosis: from

keratinocytes

Senile Keratosis: Benignproliferation ofkeratinocytes

Normal skin with mole(naevus)


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Senile Keratosis

1. InspectGenerallySingle or MultiplelesionsDiscrete (separate)or confluent (flowtogether)

2. Describe individuallesion SCAMSize (the widestdiameter), ShapeColourAssociated secondary

changeMor holo , Mar in

0.5 cmOvalPigmented(no erythema)RaisedClear well-defined


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Senile Keratosis

3. Palpate thelesionSurfaceConsistencyMobility

Tenderness

RaisedWaxy/warty

Non-mobileNon-tender

Normal temperature

2b For any pigmented lesionsABCDEF: Asymmetry Border risk of malignantmelanoma if irregular or indistinct Colour haphazard, different

shades Diameter Elevation Fitting in with other moles


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Senile Keratosis


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80 yr old man

Normal skin with mole(naevus)

If l ff t


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If lung cancer affects41,000 people per year,

malignant melanomaaffects?

A. 1,000

B. 3,000

C. 9,000

D. 11,000

If l ff t


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If lung cancer affects41,000 people per year,

malignant melanomaaffects?

A. 1,000

B. 3,000

C. 9,000

D. 11,000


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Melanocytes

Melanocytes: in epidermis, produce melaninwhich protects skin against UV radiation

Melanoma : malignant proliferation ofmelanocytes

1. Inspect Generally

Single lesionSkin generally sun

damaged


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Malignant melanoma

2. Describe individuallesion SCAMSize (the widest

diameter), ShapeColourAssociated secondarychangeMorphology, Margin(border)

0.7 cm

Discoid = cicularPigmentedSurrounding erythemaFlatIrregular border


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Malignant melanoma

2b For any pigmented lesions

:ABCDEF Asymmetry

Border Colour

Diameter Elevation

Fitting in with other moles

AsymmetricalIrregular border3 different shades ofcolour0.7cmFlat

Different fromsurrounding skin

3. Dont forget topalpate


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Malignant melanoma

O t e 36 000 poss e


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O t e 36,000 poss ediagnoses in medicine,

how many aredermatological?A. 1,000

B. 4,000

C. 9,000

D. 13,000

O t e 36 000 poss e


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O t e 36,000 poss ediagnoses in medicine,

how many aredermatological?A. 1,000

B. 4,000

C. 9,000

D. 13,000


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Uncertainty indermatology

Images from John Hopkins Medical Institute. DermAtlas.org (2000)http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012]

Definitelymelanoma

Definitely not

melanoma:Definitely senilekeratosis
http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459


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Uncertainty indermatology

Images from John Hopkins Medical Institute. DermAtlas.org (2000)

http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459 [ accessed 18 march 2012]

Definitely

melanoma

Definitely not

melanoma:Definitely senilekeratosisUrgent

referral andtreatment

Reviewin 6weeks

Reassure &advise
http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=607579459


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What have we covered?

Skin is important in health anddisease

What do I need to know aboutdermatology

How to describe a lesion

Keratinocytes & Psoriasis frombasics to management

Melanocytes and melanoma

Managing uncertainty in skin
http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxton


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Useful Information

http://dermnetnz.org/ excellent images andtreatment advice

British Association of Dermatology (bad.org.uk )Dermatology: Handbook for medical students &junior doctors 2009.

ABC of dermatology. Buxton, PK and Morris-Jones ,R. BMJ books. London. 2009.

Notes on dermatology. Liz Tatman.

www askdoctorclarke com
http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://dermnetnz.org/http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://www.askdoctorclarke.com/http://www.askdoctorclarke.com/http://www.amazon.co.uk/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&search-alias=books-uk&field-author=Paul%20K.%20Buxtonhttp://dermnetnz.org/http://dermnetnz.org/

dermatology presentation 25 oct 2012 final

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